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Introduction Globally, older adults are the fastest-growing segment of the population, and it is expected that 1 in 6 people will be aged 60 years or older by 2030. (1,2) [...], Objective. The aim of this study was to systematically review physical therapists' and physical therapist students' attitudes toward working with older adults. Methods. CINAHL, EMBASE, ERIC, MEDLINE, Scopus, PsycINFO, and SocIndex databases were searched in duplicate (from inception to March 2023). Studies that assessed knowledge on aging, intention to work with older adults or attitudes toward older adults for physical therapist students and/or clinicians, and that were written in English, Finnish, Spanish, or Swedish were included. Grey literature, qualitative studies, or articles of people with a specific diagnosis (eg, dementia) were excluded. All articles were reviewed by 2 authors independently, and consensus was required for inclusion. Data extraction was completed using a standardized data extraction sheet. Results. Of 2755 articles screened, 34 met the inclusion criteria. Twenty-five studies recruited only physical therapist students, 6 recruited only physical therapist clinicians, and 3 involved mixed samples of both. Ten intervention studies were included, all of which recruited physical therapist students. Overall, physical therapist students were observed to have predominantly positive attitudes toward older adults, while clinicians had neutral to weak positive attitudes toward older adults. Both physical therapist students and clinicians were observed to have low knowledge on aging and low intentions to work with older adults. Results from intervention studies suggest that education combined with clinical experience with older adults improves attitudes toward older adults. Conclusion. A discrepancy is observed in physical therapists in that although attitudes toward older adults are positive, a lack of knowledge on aging and a disinterest in working with older adults exists. Intervention studies suggest that clinical experience may improve attitudes toward older adults in physical therapist students. Impact. Predominantly positive attitudes toward older adults are reported by physical therapist students, while for clinicians mixed results are observed. Education coupled with clinical experiences appears to be effective interventions to improve attitudes toward older adults, but such research has only been explored in student samples. Keywords: Aged, Attitude, Knowledge, Perception, Physical Therapist Specialty

Introduction Studies have shown that up to 80% of patients remain physically inactive after spine surgery. (1-4) Individuals who are physically inactive are at higher risk of disability, diabetes, and [...], Objective. The purpose of this study was to examine the feasibility and acceptability of a wearable device and telehealth counseling physical activity intervention early after lumbar spine surgery. Methods. Sixteen patients were randomized to an 8-session physical activity intervention or to usual postoperative care after surgery. The intervention included a wearable device (ie, Fitbit) and telehealth counseling by a licensed physical therapist. The feasibility of study procedures was assessed through recruitment, randomization, retention, and participation rates. Acceptability was assessed through a satisfaction survey and median within-participant change in objective physical activity (steps per day and time spent in moderate-to-vigorous physical activity [MVPA]) and patient-reported outcomes. Results. Of 64 participants who were eligible, recruitment and randomization rates were 41 and 62%, respectively. Retention for objective physical activity and patient-reported outcomes was 94 and 100%, respectively, at 6-month follow-up. Seven (88%) participants in the intervention group completed all telehealth sessions, and 6 (75%) met step goals over the 8 sessions. All participants in the intervention group found the wearable device and telehealth counseling to be helpful and reported it much or somewhat more important than other postoperative services. Median within-participant change for steps per day improved from baseline (preoperative) to 6 months after surgery for both the intervention (1070) and usual care (679) groups, while MVPA only improved for the intervention group (2.2. minutes per day). Improvements in back and leg pain and disability were noted for both groups. No adverse events were reported in the study. Conclusion. Combining wearable technology and telehealth counseling is a feasible approach to promote the physical activity during the early postoperative period after spine surgery. Future randomized controlled trials are needed to investigate the efficacy of leveraging wearables and telehealth during postoperative rehabilitation. Impact. This study has implications for the clinical dissemination of physical activity strategies in the rehabilitation setting. Keywords: Acceptability, Physical Activity, Spine Surgery, Telehealth, Walking, Wearables

Jail leaders--are you paying attention? Since the first class in 2009 of the National Jail Leadership Command Academy (NJLCA http://www.nationaljailacademy.org), participants not only evaluated each NJLCA program, but also provided [...]

Retaining employees is vocalized as a high priority by jail leaders. Yet, there is an astonishingly poor record among jails actually committing resources to this predicament. No doubt hiring is [...]

Introduction Patient-centered goal setting is a core behavioral component of rehabilitation programs, where individuals, in collaboration with a health care provider, identify and set meaningful goals based on what is [...], Objective. The purpose of this study was to examine the association between goal attainment and patient-reported outcomes in patients who engaged in a 6-session, telephone-based, cognitive-behavioral-based physical therapy (CBPT) intervention after spine surgery. Methods. In this secondary analysis of a randomized trial, data from 112 participants (mean age = 63.3 [SD = 11.2] years; 57 [51%] women) who attended at least 2 CBPT sessions (median = 6 [range = 2-6]) were examined. At each session, participants set weekly goals and used goal attainment scaling (GAS) to report goal attainment from the previous session. The number and type of goals and percentage of goals met were tracked. An individual GAS t score was computed across sessions. Participants were categorized based on goals met as expected (GAS t score [greater than or equal to] 50) or goals not met as expected (GAS t score < 50). Six- and 12-month outcomes included disability (Oswestry Disability Index), physical and mental health (12-Item Short-Form Health Survey), physical function (Patient-Reported Outcomes Measurement Information System), pain interference (Patient-Reported Outcomes Measurement Information System), and back and leg pain intensity (numeric rating scale). Outcome differences over time between groups were examined with mixed-effects regression. Results. Participants set a median of 3 goals (range = 1-6) at each session. The most common goal categories were recreational/physical activity (36%), adopting a CBPT strategy (28%), exercising (11%), and performing activities of daily living (11%). Forty-eight participants (43%) met their goals as expected. Participants who met their goals as expected had greater physical function improvement at 6 months (estimate = 3.7; 95% CI = 1.0 to 6.5) and 12 months (estimate = 2.8; 95% CI = 0.04 to 5.6). No other outcome differences were noted. Conclusions. Goal attainment within a CBPT program was associated with 6- and 12-month improvements in postoperative physical functioning. Impact. This study highlights goal attainment as an important rehabilitation component related to physical function recovery after spine surgery. Keywords: Arthrodesis, Back Pain, Postoperative Care, Psychotherapy, Rehabilitation

Little data demonstrates the feasibility of place-based, neighborhood-level care delivered by health coaches in medically underserved neighborhoods to expand access to essential primary care and address health disparities. This concurrent mixed-methods pilot study describes experience with the innovative Neighborhood Health Hub Program in Memphis, TN. Patient characteristics, including body mass index (BMI), blood glucose, blood pressure, and service utilization, were assessed. Key informant interviews and community meetings were conducted in an initial community listening period to guide program development. Patient experience with program services was assessed using semi-structured client interviews. In year 1, 355 year-one clients were outreached, 146 (41.1%) through community events, 149 (42%) walk-ins, 38 (10.7%) door-to-door communication, 34 (9.6%) telephone, and 9 (2.5%) referral. Of the 198 (56.1%) fully screened, mean age was 52.0 (± 15.9) years, 94.5% were African American, 55.8% female, and 32.7% without a primary care provider. Baseline blood pressure was uncontrolled (≥ 140/90) in 52.3%, BMI was ≥ 30 in 50%, and random plasma glucose was high (≥ 130 mg/dl) in 23.4%. The majority (68.3%) participated in individual health coaching. Sixty-eight group sessions had an average of 4 participants (range 1–13) and were focused on chronic illness management (39.7%), exercise (26.5%), or nutrition (25.0%). Major qualitative themes highlighted the importance of social barriers and social support for chronic condition management. Place-based, neighborhood-level care delivered by health coaches in medically underserved neighborhoods is a promising approach for extending primary care, expanding access to essential preventive and primary care, reducing health disparities, and improving patient outcomes.

Introduction Falls are common among community-dwelling older adults, with approximately 30% reporting at least 1 fall annually. (1) The immediate consequences of falls can be serious and include physical injuries [...], Objective. The authors sought to systematically review the existing literature on the falls-related diagnostic test properties of the Functional Reach Test (FRT), single-leg stance test (SLST), and Tinetti Performance-Oriented Mobility Assessment (POMA) in older adults across settings and patient populations. Methods. The PubMed, EMBASE, and CINAHL databases were searched (inception--July 2020). Inclusion criteria were participants aged 60 years or more, prospectively recorded falls, and the reporting of falls-related predictive validity. Manuscripts not published in English were excluded. Methodological quality of reporting was assessed using the Tooth Scale. Results. Of 1071 studies reviewed, 21 met the inclusion criteria (12 POMA, 8 FRT, 6 SLST). Seven studies (58.3%) used a modified version of the POMA, and 3 (37.5%) used a modified FRT. For the outcome of any fall, the respective ranges of sensitivity and specificity were 0.076 to 0.615 and 0.695 to 0.97 for the POMA, 0.27 to 0.70 and 0.52 to 0.83 for the modified POMA, 0.73 and 0.88 for the FRT, 0.47 to 0.682 and 0.59 to 0.788 for the modified FRT, and 0.51 and 0.61 for the SLST in community-dwelling older adults. For the SLST, the sensitivity and specificity for recurrent falls in the community-dwelling setting were 0.33 and 0.712, respectively. Conclusion. All the clinical tests of balance demonstrated an overall low diagnostic accuracy and a consistent inability to correctly identify fallers. None of these tests individually are able to predict future falls in older adults. Future research should develop a better understanding of the role that clinical tests of balance play in the comprehensive assessment of falls risk in older adults. Impact. Neither the FRT, SLST, nor POMA alone shows consistent evidence of being able to correctly identify fallers across fall types, settings, or older adult subpopulations. These clinical tests of balance cannot substitute a comprehensive falls risk assessment and thus should be incorporated in practice solely to identify and track balance impairment in older adults. Keywords: Accidental Falls, Gait, Postural Balance, Predictive Value of Tests, Systemic Review

With over 50 percent of marriages ending in divorce, career counselors need to be aware of the special issues that confront partners who are contemplating, in the throes of, or in the aftermath of a divorce. This chapter explores the unique career issues individuals confront when involved in a divorce including issues related to: 1) divorce laws in California; 2) the supporting partner; 3) the supported partner; 4) the children; and 5) the career counselor as part of a professional team. It is the career counselors' responsibility to consider the unique situation faced by each divorced/divorcing client, and to keep informed about divorce laws and how they impact the career counseling process. Since divorce involves emotional, familial, legal and financial realities that overlap with career issues, the career counselor must remain sensitive to the individual needs of each client and make referrals and work as a team with other professionals when necessary. (GCP)

Whether we use technology with young children--and if so, how--are critical issues facing early childhood educators and parents. This Digest points out that many researchers do not recommend that children under 3 years old use computers. The Digest also notes that many educators use computers with young children in ways that are developmentally inappropriate. However, developmentally appropriate ways to use computers with 3- and 4-year-olds are different from the ways computers are used in kindergarten and the primary grades. Research has shown that the cognitive and social benefits of providing computers to young children vary depending upon the kind of computer experiences offered. The Digest suggests, as a first step to integrating computers in classrooms, organizing a study group of all the individuals who have expressed interest in children using computers, then summarizing the benefits of using computers with young children, and discussing goals for the year, including the cost of computers and teacher training. The Digest identifies four critical components of teacher training: practical experience, workshops, models and mentors, and supervisory follow-up. (Contains 13 references.) (LPP)

In the current social climate, the national focus on 'defunding the police' or 'de-incarcerating jails' is unlikely to be resolved in the immediate future. The public seeks fair, equitable, well-functioning [...]

Chronic daily pain affects over 40 million individuals in the United States, with approximately 10.6 million people reporting high-impact pain that results in significant activity limitation or participation restriction. (1) [...], Objective. Changing Behavior through Physical Therapy (CBPT), a cognitive-behavioral-based program, has been shown to improve outcomes after lumbar spine surgery in patients with a high psychosocial risk profile; however, little is known about potential mechanisms associated with CBPT treatment effects. The purpose of this study was to explore potential mediators underlying CBPT efficacy after spine surgery. Methods. In this secondary analysis, 86 participants were enrolled in a randomized trial comparing a postoperative CBPT (n = 43) and education program (n = 43). Participants completed validated questionnaires at 6 weeks (baseline) and 3 and 6 months following surgery for back pain (Brief Pain Inventory), disability (Oswestry Disability Index), physical health (12-Item Short-Form Health Survey), fear of movement (Tampa Scale for Kinesiophobia), pain catastrophizing (Pain Catastrophizing Scale), and pain self-efficacy (Pain Self-Efficacy Questionnaire). Parallel multiple mediation analyses using Statistical Package for the Social Sciences (SPSS) were conducted to examine whether 3- and 6-month changes in fear of movement, pain catastrophizing, and pain self-efficacy mediate treatment outcome effects at 6 months. Results. Six-month changes, but not 3-month changes, in fear of movement and pain self-efficacy mediated postoperative outcomes at 6 months. Specifically, changes in fear of movement mediated the effects of CBPT treatment on disability (indirect effect = -2.0 [95% CI = -4.3 to 0.3]), whereas changes in pain self-efficacy mediated the effects of CBPT treatment on physical health (indirect effect = 3.5 [95% CI = 1.2 to 6.1]). Conclusions. This study advances evidence on potential mechanisms underlying cognitive-behavioral strategies. Future work with larger samples is needed to establish whether these factors are a definitive causal mechanism. Impact. Fear of movement and pain self-efficacy may be important mechanisms to consider when developing and testing psychologically informed physical therapy programs.

Whether we use technology with young children--and if so, how--are critical issues facing early childhood educators and parents. This Spanish-language digest points out that many researchers do not recommend that children under 3 years old use computers. The digest also notes that many educators use computers with young children in ways that are developmentally inappropriate. However, developmentally appropriate ways to use computers with 3- and 4-year-olds are different from the ways we use computers in kindergarten and the primary grades. Research has shown that the cognitive and social benefits of providing computers to young children vary depending upon the kind of computer experiences offered. The digest suggests, as a first step to integrating computers in classrooms, organizing a study group of all the individuals who have expressed interest in children using computers, then summarizing the benefits of using computers with young children and discussing goals for the year, including the cost of computers and teacher training. The digest identifies four critical components of teacher training: practical experience, workshops, models and mentors, and supervisory follow-up. (LPP)

Successful walking is a substantial contributor to quality of life in people with lower-limb amputation (PLLA), yet gait difficulties are common. Evidence-based exercise guidelines are necessary for PLLA with different clinical characteristics and at different phases of recovery. To systematically review the literature evaluating effects of exercise interventions on gait outcomes in PLLA at subacute and chronic stages of recovery. Databases MEDLINE, EMBASE, CINAHL, SPORTDiscus, Scopus, and the Cochrane Library were searched (inception to May 10, 2022). Inclusion criteria: randomized controlled trials assessing gait outcomes following exercise intervention; subjects were PLLA ≥18 years of age and used a prosthesis for walking. Meta-analysis using random effects with inverse variance to generate standardized mean differences (SMDs) was completed for primary gait outcomes. Subgroup analysis was conducted for the recovery phase (i.e., subacute and chronic) and level of amputation (e.g., transfemoral and transtibial). Of 16 included articles, 4 studies examined the subacute phase of recovery, whereas 12 examined the chronic phase. Subacute interventions were 30 minutes, 1–7 times/week, for 2–12 weeks. Chronic interventions were 15–60-minutes, 2–3 times/week, for 4–16 weeks. Low–moderate level evidence was shown for a small improvement in the subacute phase (SMD = 0.42, 95% confidence interval [0.06–0.79], I2= 46.0%) and a moderate improvement in the chronic phase (SMD = 0.67, 95% confidence interval [0.40–0.94], I2= 0.0%) in favor of exercise intervention groups. Multicomponent exercise programs consisting of gait, balance, and strength training are effective at improving gait outcomes in PLLA at subacute and chronic phases of recovery. The optimal duration and frequency of exercise is unclear because of variation between interventions, highlighting an area for future work.

Prescription stimulant misuse (PSM) has been studied extensively in college populations, but few studies have examined how PSM changes after graduation. We used a longitudinal design to follow individuals at risk for PSM 2 years after college graduation to document PSM prevalence, motives, and predictors of PSM persistence. Participants from two small, private colleges completed online surveys focused on intrapersonal, interpersonal, and sociocultural predictors of PSM. Overall, PSM declined over time. Lack of premeditation, perceived peer norms, positive expectancies, media exposure, and other substance use were associated with continued PSM; however, only lack of premeditation, descriptive norms, and other substance use predicted PSM in a multivariate model. This preliminary study suggests dispositional and behavioral risk factors may help to explain why PSM persists after college. Interventions that enhance decision-making skills, correct misperceptions about peers’ PSM, and reduce polysubstance use may be effective in curbing PSM in college graduates.

What skills, knowledge, and abilities do jail leaders need in order to be credible and successful? Having started with the July/August 2015 issue of American Jails, we explored the 22 [...]

What skills, knowledge, and abilities do jail leaders need in order to be credible and successful? Having started with the July/August 2015 issue of American Jails, we are exploring the [...]

What skills, knowledge, and abilities do jail leaders need in order to be credible and successful? Having started with the July/August 2015 issue of American Jails, we are exploring the [...]

What skills, knowledge, and abilities do jail leaders need in order to be credible and successful? Having started with the July/August 2015 issue of American Jails, we are exploring the [...]

That's how people remember Francis R. 'Dick' Ford, the first Executive Director of the American Jail Association, who died on Tuesday, July 23, 2019, at the age of 90. Dick [...]

Study Design: Longitudinal, qualitative cohort study. Objectives: To understand how people with newly acquired spinal cord injury (PWS) and their support person (SP) define recovery and successful community reintegration (CR) across the first 12 months post-injury (mpi) and their satisfaction with the rate of recovery and reintegration experienced. Setting: Academic and Veterans hospitals in Midwest USA. Methods: In-depth, semi-structured interviews were conducted in two cohorts of PWS and SP during the initial inpatient rehabilitation stay, at 6 mpi, and at 12 mpi. Recordings were transcribed; four authors independently undertook line-by-line coding. The team discussed codes to reach consensus and synthesize into broader themes within the International Classification of Function, Disability, and Health and Transformative frameworks. Results: Data are reported on 23 PWS and 21 SP. PWS and SP are similar in defining recovery as gaining motor function and achieving independence. However, SP more frequently define recovery in terms of maintaining positivity and emotional recovery. At 12 mpi both groups shift to define recovery according to progress. Social roles, being active, and employment are persistent themes of how PWS and SP define successful CR. However, SP also frequently define successful CR as reestablishing identity and emotional adjustment. Veterans with SCI less frequently defined successful CR as employment. Conclusions: This study is the first to reveal how PWS and SP define recovery and reintegration during the first 12 mpi. Given decreasing lengths of stay, this information can be used to tailor rehabilitation strategies during the critical first year of injury to optimize recovery.

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening form of hemorrhagic stroke and is more common in women than men, typically occurring between 40 and 60 years old. (1) It was [...], Introduction: It was observed that women with aneurysmal subarachnoid hemorrhage (aSAH) tended to have earlier menses than a typical 21- to 28-day cycle. The goal was to determine whether there is an association between aSAH and early onset of menses. Methods: All cases of aSAH in women aged 18 to 55 years who were admitted to our facility&apos;s neuroscience intensive care unit from June 1, 2011, to June 30, 2012, were reviewed. The electronic healthcare record for each of these patients was examined for documentation of menses onset, computed tomography of the head, brain aneurysm characteristics, modified Fisher score and Glasgow Coma Scale on admission, presence/absence of vasospasm, medical/ surgical history, and use of medications that affect the menstrual cycle. The mean onset of menses in this study population was compared with the mean of 21 to 28 days with the 1 -sample t test. Results: During the study period, 103 patients with subarachnoid hemorrhage were admitted. Sixty-one were women, and 15 were aged 18 to 55 years. Nine of the 15 (60%) had documentation of menses occurring during their initial week of hospitalization; 1 patient had documentation of menses on hospital day 12. There is a significant difference when the mean onset of menses in our patient population is compared with the approximate normal menstrual cycle of 21 to 28 days (P < .01). Conclusion: Early onset of menses or abnormal uterine bleeding after SAH may occur in women with aSAH and typically within the first 7 to 10 days after intracranial aneurysm rupture. The physiologic cause of early onset of menses after aSAH, whether primary or secondary, remains unknown. Keywords: anovulatory uterine bleeding, intracranial hemorrhage, menstrual bleeding, stroke, subarachnoid hemorrhage, uterine bleeding, women

What skills, knowledge, and abilities do jail leaders need in order to be credible and successful? Beginning with the July/August 2015 issue of American Jails, we are exploring the 22 [...]

What skills, knowledge, and abilities do jail leaders need in order to be credible and successful? Beginning with the July/August 2015 issue of American Jails, we are exploring the 22 [...]

What skills, knowledge, and abilities do jail leaders need in order to be a credible and successful? Beginning with the July/August 2015 issue of American Jails, we are exploring the [...]

What skills, knowledge, and abilities do you need in order to be a credible and successful jail leader? Beginning with the July/August 2015 issue of American Jails, we are exploring [...]

What skills, knowledge, and abilities do you need in order to be a credible and successful jail leader? Beginning with the July/August 2015 issue of American Jails, we are exploring [...]

During the course of an intact marriage, the parties enjoy a relationship of trust, and many financial decisions are made without regard to the full impact of those decisions should [...]

It's our job to pray for the dead. Several years ago, my brother and I found ourselves in the throes of that middle-aged rite of passage--the clearing out of our [...]

There are 8,000 to 10,000 Baby Boomers retiring every day, depending on your source of data. The current economic recovery and the Patient Prote ction and Affordable Health Care Act's [...]

Exertional heat stroke is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and exertional heat stroke. Identifying the athlete with suspected exertional heat stroke early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from exertional heat stroke is variable and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.

ABSTRACTHow do judges decide issues of equality? While prior scholarship demonstrates that judicial attributes such as partisan identification, gender, race, age, and career backgrounds help elucidate judicial decision-making, considerably less attention has been devoted to how judicial empathy may influence or condition judicial decision-making. Such scholarly attention is especially lacking in the study of courts outside of the United States. To bridge this critical gap, we examine how judicial empathy affects decision-making behavior by analyzing data from the Supreme Court of Canada from 1982 to 2015. We find compelling evidence that trailblazer women’s unique personal experiences exert a strong influence on judicial behavior within the Canadian Supreme Court. In fact, our findings demonstrate that the effects of judicial empathy extend across a broader array of discrimination cases in Canada compared to previous findings on the American courts. We find that trailblazer women have a greater propensity to vote in favor of discrimination claimants compared to their male peers. Normatively, these effects manifest as judicial empathy in discrimination cases where trailblazers themselves likely faced upward mobility challenges.

Utilities face immediate and unprecedented operational challenges--from asset failures to regulatory pressures--and they're all exacerbated by a growing dearth of critical skills needed to effectively run today's and tomorrow's utility. [...]

The Bureau of Justice Assistance (BJA) in 2007 funded an initiative to bring together jail leaders. The bureau's goal was to identify and prioritize the issues that challenge their jails [...]

The Internal Audit Activity's (IIA) definition of internal auditing in June 1999 has further expanded the competencies and knowledge required of the internal auditor. These competencies are a combination of concepts learned through formal education, professional development, and training.

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2010.02955.x Byline: Susan E. Hickman (*[dagger]), Christine A. Nelson ([dagger]), Nancy A. Perrin ([double dagger]), Alvin H. Moss (s.), Bernard J. Hammes ([parallel]), Susan W. Tolle (#) Keywords: end-of-life; ethics; nursing facility; do not resuscitate; do not hospitalize Abstract: OBJECTIVES: To evaluate the relationship between two methods to communicate treatment preferences (Physician Orders for Life-Sustaining Treatment (POLST) program vs traditional practices) and documentation of life-sustaining treatment orders, symptom assessment and management, and use of life-sustaining treatments. DESIGN: Retrospective observational cohort study conducted between June 2006 and April 2007. SETTING: A stratified, random sample of 90 Medicaid-eligible nursing facilities in Oregon, Wisconsin, and West Virginia. PARTICIPANTS: One thousand seven hundred eleven living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. MEASUREMENTS: Life-sustaining treatment orders; pain, shortness of breath, and related treatments over a 7-day period; and use of life-sustaining treatments over a 60-day period. RESULTS: Residents with POLST forms were more likely to have orders about life-sustaining treatment preferences beyond cardiopulmonary resuscitation than residents without (98.0% vs 16.1%, P CONCLUSION: Residents with POLST forms were more likely to have treatment preferences documented as medical orders than those who did not, but there were no differences in symptom management or assessment. POLST orders restricting medical interventions were associated with less use of life-sustaining treatments. Findings suggest that the POLST program offers significant advantages over traditional methods to communicate preferences about life-sustaining treatments. Author Affiliation: (*)School of Nursing, Indiana University, Indianapolis, Indiana; Schools of ([dagger])Nursing and (#)Medicine, Oregon Health & Science University, Portland, Oregon ([double dagger])Center for Health Research, Kaiser Permanente Northwest (s.)School of Medicine, West Virginia University, Morgantown, West Virginia ([parallel])Gundersen Lutheran Medical Foundation, LaCrosse, Wisconsin. Article note: Address correspondence to Susan E. Hickman, Indiana University School of Nursing, 1111 Middle Drive, 451F, Indianapolis, IN 46202. E-mail: hickman@iupui.edu

Persuasive citation of legal authority is an essential part of legal writing. Proper citation involves knowing not only the basic form for citing cases, constitutions, statutes, rules, books, articles, and [...]

A lawyer confidently strides into the courthouse. To the client, it is like being wheeled into the operating room for the removal of cancer. Fear, gut-wrenching uncertainty and ignorance control [...]

PRACTICE RECOMMENDATIONS * Screen all patients for chronic kidney disease (CrD) by estimated glomerular filtration rate and persistent proteinuria. (A) * Treat all CKD patients with angiotensin II receptor blockers [...]

"Lawfare" is a weapon designed to destroy the enemy by using, misusing, and abusing the legal system and the media in order to raise a public outcry against that enemy. [...]

Although impairment in balance is acknowledged as a major predictor of falls, systematic reviews have been limited in recommending specific clinical assessment scales of balance. (1-4) There are many risk [...], Background. Screening should have simple and easy-to-administer methods that identify impairments associated with future fall risk, but there is a lack of literature supporting validation for their use. Objective. The aim of this study was to evaluate the independent contribution of balance assessment on future fall risk, using 5 methods to quantify balance impairment, for the outcomes "any fall" and "any injurious fall" in community-dwelling older adults who are higher functioning. Design. This was a prospective cohort study. Methods. A sample of 210 community-dwelling older adults (70% male, 30% female; mean age=79.9 years, SD=4.7) received a comprehensive geriatric assessment at baseline, which included the Berg Balance Scale to measure balance. Information on dally falls was collected for 12 months by each participant&apos;s monthly submission of a falls log calendar. Results. Seventy-eight people (43%) fell, of whom 54 (30%) sustained an injurious fall and 32 (18%) had recurrent falls ([greater than or equal to] 2 falls). Different balance measurement methods identified different numbers of people as impaired. Adjusted relative risk (RR) estimates for an increased risk of any fall were 1.58 (95% confidence interval [CI]=1.06, 2.35) for self-report of balance problems, 1.58 (95% CI=1.03, 2.41) for one-leg stance, and 1.46 (95% CI=1.02, 2.09) for limits of stability. An adjusted RR estimate for an increased risk of an injurious fall of 1.95 (95% CI=1.15, 3.31) was found for self-report of balance problems. Limitations. The study was a secondary analysis of data. Conclusions. Not all methods of evaluating balance impairment are associated with falls. The number of people identified as having balance impairment varies with the measurement tool; therefore, the measurement tools are not interchangeable or equivalent in defining an at-risk population. The thresholds established in this study indicate individuals who should receive further comprehensive fall assessment and treatment to prevent falls.